Biomedical subjects
Publications and source records attributed to K R Krishnan.
Antidepressants are often effective in the management of chronic pain syndromes. They are most useful for certain types of pain complaints, such as headache, diabetic neuropathy, arthritis and facial pain. The choice of antidepressant depends on the side effects and the patient's ability to tolerate the medication. The dose is usually half of that used in the management of depression.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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A blunted growth hormone (GH) response to clonidine and other pharmacologic stimuli has been reported in patients with depression. This blunted growth hormone response to clonidine has led to the speculation that there is a central alpha-2 adrenergic receptor subsensitivity in depression. This hypothesis is based on the assumption that the pituitary somatotroph response to growth hormone-releasing factor (GHRF) is not altered in depression. In the present preliminary study, the somatotroph response to GHRF in depressed patients and normal controls has been evaluated in four depressed patients and four age- and sex-matched controls. The GH response to GRF is highly variable both in normal individuals and in the depressed patients studied. Larger numbers of patients and controls must be studied before any definitive conclusions can be drawn about GH responses to GRF in depressed patients.
The case histories of 198 consecutive traumatic spinal cord injured patients treated at the Mersey Regional Spinal Injuries Centre between 1975 and 1982 were reviewed. One hundred and seventy six were treated conservatively and 22 surgically. Functional outcome, complications, radiological reduction achieved and duration of initial hospital admission of the two groups are outlined. Prospective, multicentred trials are required to enable valid comparisons of treatments to be made. Patient expectations, state resources and local factors may determine which philosophy of spinal treatment is most appropriate for different centres in different countries.
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Recent studies have shown that depression can be assessed in patients who have chronic pain. This study shows that various subtypes of depression can be differentiated in such patients using a standardized diagnostic schema for psychiatric disorders and a self-rating instrument for assessing the level of psychologic distress. In addition, when examining the onset of pain and subtypes of depression, there was no correlation between the onset of major depression and pain, whereas there was a strong positive correlation between the onset of chronic depression and pain. The recognition of the subtypes of depression has clinical implications in the management of the patient with chronic pain and depression.
The authors administered the growth hormone-releasing factor (GRF) stimulation test to 19 patients with major depression and 19 age- and sex-matched control subjects to test the hypothesis that a blunted growth hormone (GH) response to clonidine reflects a central alpha 2-adrenergic receptor subsensitivity in depression. GH response to GRF was significantly higher in patients with depression than in control subjects. This group difference was mainly attributable to three of the 19 depressed patients who exhibited markedly high GH responses to GRF. These results suggest that the blunted GH response to clonidine seen in patients with depression is not due to a pituitary defect in GH secretion.
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The effects of the alpha-adrenergic agonist methoxamine on the human hypothalamic-pituitary-adrenal axis was assessed by a placebo-controlled study in the morning and one in the evening. A 5-mg iv bolus dose of methoxamine in normal subjects caused a significant rise in plasma ACTH and cortisol concentrations in the morning study. However, no significant change in plasma cortisol or ACTH concentrations was noted during the evening study. These studies suggest the existence of a diurnal variation in alpha 1-adrenergic regulation of the hypothalamic-pituitary-adrenal axis.
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This article discusses the current controversy surrounding the diagnostic utility of the Dexamethasone Suppression Test, addresses the questions raised by the recent editorial by Ross in this journal, discusses the general principles behind the development of tests, and estimates their diagnostic utility. This discussion aims to clarify some aspects of the controversy. It presents an operational analysis of the Dexamethasone Suppression Test as utilized at a state hospital. This operational analysis shows that the test may be useful in distinguishing schizophrenia from psychotic depression, and mania from schizophrenia. Furthermore, it shows that the test is not useful as a screening test. These results are compared with those obtained by other investigators. The authors further show how test results can be used rationally by clinicians by so-called threshold analysis. Clinical data from a state hospital are used to illustrate this.
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Patients with chronic pain syndromes often have concomitant depression. In this paper we discuss the clinical and biologic characteristics of depression, and also briefly discuss the various subtypes of depression, potential modes in the development of depression, neuroendocrine markers of depression, and patient response to antidepressant medication.